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NPR Health

Africa is struggling with low vaccination rate

AYESHA RASCOE, HOST:

Omicron, the new variant of COVID-19, has now been detected in dozens of countries around the world. While we do not know where the variant started, its emergence highlights global disparities in vaccination rates, which experts predicted would allow the coronavirus more opportunities to mutate and spread. Here's how South African President Cyril Ramaphosa put it recently.

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PRESIDENT CYRIL RAMAPHOSA: The emergence of the omicron variant should be a wake-up call to the world that vaccine inequality cannot be allowed to continue. Until everyone is vaccinated, everyone will continue to be at risk.

RASCOE: We're joined now by Saad Omer, epidemiologist and director of the Yale Institute for Global Health, to talk about the challenges many poorer nations still face in their vaccination efforts. Thank you so much for joining us.

SAAD OMER: Happy to be here.

RASCOE: There's been a lot of focus on the vaccination rate in Africa because that's where omicron was first detected. Some estimates have placed the number of people who have gotten at least one dose of a vaccine - they are at 10%, while it's over 70% in the U.S. and Canada. Is that disparity fueled by a supply issue, or are there other factors at play?

OMER: Until recently, supply was the main issue. But supply projections have improved, even though the number of doses in country are still low. We are now focusing on some of the other factors that have emerged as bottlenecks. And these factors include fragile health systems, the fact that these countries weren't able to build their capacity due to uncertainty in supply and vaccine acceptance.

RASCOE: Can we dig a little bit more into that infrastructure issue? President Biden's chief medical adviser, Dr. Anthony Fauci, said recently that many of the doses that have been shipped have not been used and that some African countries have told the U.S. to stop sending vaccines right now because they haven't been able to use what they've received. So what kind of support or infrastructure is really needed to get shots in the arm quickly? Who's in a position to do that work?

OMER: You know, some of these statements make it sound that African countries cannot absorb these vaccines, even if these vaccines are delivered. Just to be clear, if you are a low- and middle-income country and you don't know which vaccines are going to be given to you and how much, you cannot plan, and you cannot just hire people to let them sit around. You cannot order the right kinds of freezers. You don't have the money to throw at this problem. And so because of that, now that vaccine supply is improving, they are taking a little bit of a breather in terms of saying, look. Give us a second to increase that capacity, and then give us a little bit more vaccine. I would remind people that even in the U.S., for the first few months, we have had these kinds of issues where the supply was increasing, and we didn't have enough access in communities where the vaccine was needed most. And so there needs to be an investment in helping these countries build the delivery infrastructure and focus on end-to-end solutions of getting vaccines into arms.

RASCOE: About vaccine hesitancy - it's definitely been an issue here in the U.S., and the Africa director of the World Health Organization has said it's a factor in the rollout there, too. How big a factor is it compared with these other factors that we talked about?

OMER: So we actually measured the baseline vaccine hesitancy - or acceptance - in many parts of the world right before the start of immunization campaigns around the world. So we did a multi-country study that had 10 low- and middle-income countries in Africa and South Asia and Russia and the U.S. And this study was done in late 2020. And what we found was at that time, overall, that vaccine acceptance was higher at baseline in low- and middle-income countries. Since then, partially - but not completely due to supply uncertainties - due to the fact that countries could not promote vaccines because they didn't want to create more demand without having the supply, slowly, vaccine acceptance has gone down in several low- and middle-income countries. We need to invest in vaccine communications, vaccine acceptance. But we need to make sure that that's not used as an excuse for not having enough doses because doses are necessary to get people protected. In May 2020, we did a national study in the U.S. to show that the U.S. vaccine demand was a bit soft, that not everyone will accept the vaccine. We knew that, but it was never used as an excuse for have fewer doses - and rightfully so.

RASCOE: Do you feel like there is a need for supply but also for education campaigns to help combat whatever hesitancy that there might be? Is there basically a need for both?

OMER: Absolutely, so that's the next step. The U.S. has worked with partners like UNICEF and WHO in the context of smallpox, in the context of Ebola, in the context of polio. In polio, the so-called stop TB training, which is the mainstay of field efforts of polio elimination and eradication that includes vaccine acceptance, is heavily supported, and some parts are run by the CDC in collaboration with UNICEF, et cetera. So there are avenues for investments in this area.

RASCOE: Dr. Saad Omer, director of the Yale Institute for Global Health, thank you so much for joining us.

OMER: My pleasure. Transcript provided by NPR, Copyright NPR.